Anatomic robot assisted radical cystectomy in female: step by step technique
Robot assisted radical cystectomy (RARC) in female is a challenging procedure. We describe step by step surgical technique, presenting perioperative outcomes of a 66 yr-old female patient with a cT1/N0/M0 high grade recurrent bladder cancer who underwent RARC with totally intracorporeal orthotopic neobladder (iON).
Key steps were: ligation of gonadic pedicles, dissection of umbilical and uterine arteries and the ureters, dissection of bladder pedicles, opening of the vagina and creation of the plane between vagina and bladder. Urethra was cut and Foley catheter secured with the entire specimen into an Endocatch bag to minimize any urine spillage. Specimen was removed through the vagina. Extended pelvic lymph node dissection. Vagina was sutured and a peritoneal flap used as posterior neobladder support.
Operative time was 295 minutes, EBL was 250 mL, time to flatus was 3 days. Hemoglobin and creatinine at discharge were 10.3 g/dL and 0.76 mg/dL, respectively. Pathologic stage was pT0 pN0. Nodes removed were 26. Postoperative course was uneventful. Daytime continence was recovered after 45 days.
A meticulous dissection of bladder vascular suppliers, a natural orifice specimen retrieval and the ease of posterior neobladder support, thanks to a perfect vision of the small pelvis anatomic structures, may contribute to minimize invasiveness, improving outcomes of RARC in female patients.